434416728-7-21-2021-07-CC-SYIP-C55L2J-20210721082223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416728
Report Date: 07/20/2021
Date Signed: 07/21/2021 08:22:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KASSEL, ALEXANDRIA		FACILITY NUMBER:	434416728
ADMINISTRATOR:	ALEXANDRIA, KASSEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 427-2819
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 0	DATE:	07/20/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Alexandria "Alex" Kassel		TIME COMPLETED:	11:35 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samantha Yip conducted an announced pre-licensing inspection. LPA met with Applicant Alexandria "Alex" Kassel and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a large Family Child Care Home (FCCH) license. Applicant has over a year of experience working in a child care center, which meets the requirement to apply for a large FCCH. A fire clearance for 14 children was granted on 07/08/2021. Present during today's inspection were Applicant and her spouse. All adults have cleared fingerprints. Applicant also has three children. Applicant does have any area to post required postings, such as license, Emergency Disaster Plan, Notification of parents. The hours of operation are Monday through Friday 6AM to 6PM and one Saturday per month from 10AM to 11PM. There is a working phone in the home. Applicant owns the home and plans on obtaining daycare insurance. Applicant understands that she needs to use the Affidavit Regarding Liability Insurance if she does not plan on obtaining daycare insurance. LPA toured the inside and outside of the home with Applicant. The off-limit areas inside the home are the two closets in the hallway, garage, master bedroom, and bedroom across the master bedroom. The off-limit areas outside the home are the backyard, and the left side of the yard. The home was observed to be clean. There is a fireplace in the home, which is barricaded. There is sufficient amount of toys and equipment for the children. All cleaning supplies, disinfectant, and other items that are dangerous to children were observed to be inaccessible. There is fully charged fire extinguisher, smoke detector, and carbon ---------------------CONTINUES ON 809 DATED 07/20/2021 PAGE 2----------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KASSEL, ALEXANDRIA	FACILITY NUMBER: 434416728
	VISIT DATE: 07/20/2021

NARRATIVE

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--------------------CONTINUATION OF 809 DATED 07/20/2021 PAGE 1------------------------

monoxide detector. Applicant stated that there are weapons, such as firearms, stored in the home, which were locked in the off-limit area. The weapon and the ammunition were stored separately. Applicant does have pets in the home. LPA discussed with Applicant that smoking is not permitted. LPA observed that there was a baby walker in the home. Applicant understands that baby walkers cannot be used for children in care.

Applicant stated that she is only planning on using the right side of the yard is used and is fenced. There is a trampoline that is in the off-limit area of the home. Applicant stated that she will submit a waiver request if she plan on using the trampoline for the children in care. There is a pool and hot tub in the backyard, which has required fencing. The gate self-latches, locks, and swings outward. There were no other bodies of water in the home.

Applicant does not plan on transporting children at this time, but understands that children cannot be left alone and unattended in park vehicles. Applicant does plan on providing Incidental Medical Services. Applicant stated she will submit a Plan for Providing Incidental Medical Services to Licensing. The form of discipline that Applicant plans on using is redirection. Applicant understands that children's personal rights should not be violated, including no corporal punishment.

LPA provided and discussed with Applicant the updated Licensing form packet. Isolation of sick children, supervision of children, requirement for reporting suspected child abuse, usual incidents/injuries, and heat related illness were discussed with Applicant. LPA also discussed with Applicant about capacity options. Applicant understands that her own children will count under her capacity until they turn 10 years old. LPA also discussed with Applicant that if she does not have an assistant that her capacity will revert back to the Small FCCH. LPA also discussed with Applicant that fire/disaster drill needs to be conducted every 6 months and documented. LPA also discussed with Applicant the new safe sleep regulations.

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SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KASSEL, ALEXANDRIA	FACILITY NUMBER: 434416728
	VISIT DATE: 07/20/2021

NARRATIVE

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------------------CONTINUATION OF 809 DATED 07/20/2021 PAGE 2----------------------------

Applicant completed her CPR/1st Aid on 03/15/2021 through Adam's Safety Training. CPR/1st Aid card did not have an EMSA sticker. Applicant stated that she will contact program and obtain the EMSA sticker. Applicant's certificate for Preventive Health and Safety is on file; along with her immunization record for measles, pertussis, and influenza. Applicant completed the Mandated Reporter training on 09/27/2020. LPA reminded her that Mandated Reporter training requires renewal every 2 years.

The adults living in the home are Applicant and her spouse. All adults have cleared criminal records, child abused index clearance, and TB test. LPA informed Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA conducted an exit interview with Applicant Alex Kassel. LPA advised Applicant upon approval of Licensing Management, a license for Large Family Child Care Home will be granted and issued to Applicant upon completion of the following items:
- CPR/1st Aid card with EMSA sticker
- Plan for Providing Incidental Medical Services

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC809 (FAS) - (06/04)

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